Abatacept (Orencia®) for injection for intravenous use

Abdominoplasty and/or Panniculectomy

Acupuncture

Add-on Codes

Attachment A

Agalsidase beta (Fabrazyme®)

Air or Sea Ambulance Transport Services

Airway-Clearance Devices for Use in the Home Setting

Alglucosidase alfas, rhGAA (Myozyme®, Lumizyme®)

Allergy Immunotherapy

AlloMap™ Molecular Expression Testing for Heart Transplant Rejection

Alpha 1-Proteinase Inhibitor Therapy (eg, Prolastin, Aralast, Aralast NP, Glassia, Zemaira)

Alternative Therapies and Complementary Medicine

Always Bundled Procedure Codes

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Ambulatory Blood Pressure Monitoring (ABPM)

Ambulatory, Real-Time Cardiac Surveillance System

Anesthesia Services for a Cancelled or Discontinued Procedure

Ankle-Foot/Knee-Ankle-Foot Orthoses

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Apheresis Therapy

Application and Removal of Tattoos

Arthroscopic Electrothermal Joint Repair

Artificial Intervertebral Disc Insertion

Assays of Genetic Expression in Tumor Tissue for Breast Cancer Prognosis

Auditory Brainstem Implant

Autologous Blood Services (Collection, Storage, Transfusion, and Perioperative Salvage)

Autologous Chondrocyte Implantation (ACI)/Carticel® and Other Cell-based Treatments of Focal Articular Cartilage Lesions

Automatic External and Wearable Cardioverter Defibrillators

Balloon Sinuplasty for the Treatment of Chronic Sinusitis

Bariatric Surgery

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Belatacept (Nulojix®)

Belimumab (Benlysta®)

Bendamustine Hydrochloride (Treanda®)

Bevacizumab (Avastin®)

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Billing for Professional Office-Based Services Performed in an Outpatient Office-Based Setting Located within a Facility or on a Facility Campus

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Billing Requirements for Multiple Births for Professional Providers

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Biofeedback Therapy

Bioimpedance for the Detection of Lymphedema

Blepharoplasty, Repair of Blepharoptosis, Repair of Brow Ptosis, and Canthoplasty/Canthopexy

Blood Pressure Devices for Home Use

Bone-Anchored (Osseointegrated) Hearing Aids, Implantable Bone-Conduction Hearing Aids, and Semi-Implantable Hearing Aids

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Bone Growth Stimulators

Bone Mineral Density (BMD) Testing

Bortezomib (Velcade®)

Botulinum Toxin Agents

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Brachytherapy

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Bulking Agents for the Treatment of Stress Urinary Incontinence (SUI) due to Intrinsic Sphincter Deficiency (ISD) and for the Treatment of Vesicoureteral Reflux (VUR)

C1 Esterase Inhibitors (Human): Cinryze® and Berinert®

Cabazitaxel (Jevtana®)

Cardiac Event Detection Monitoring (External Loop Monitoring)

Cardiac Rehabilitation and Intensive Cardiac Rehabilitation Programs

Cast and Splint Applications and Associated Supplies Provided in the Office Setting

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Cataract Surgery

Catheter Ablation of Cardiac Arrhythmias

Cervical Traction for In-home Use

Cetuximab (Erbitux®)

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Chemical Peels

Chiropractic Spinal and Extraspinal Manipulation Therapy

Circumcision

Coagulation Factors for Hemophilia

Cochlear Implant

Cold Laser Therapy

Colorectal Cancer Screening

Complex Regional Pain Syndrome (CRPS) Parenteral Treatments

Compression Garments

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Computer-Assisted Musculoskeletal Surgical Navigational Orthopedic Procedure

Computer Aided Detection (CAD) System for use with Chest Radiographs

Computer Analysis and Generation of Automated Data in Conjunction with Diagnostic Studies

Continuous Local Delivery of Anesthesia to Operative Sites Using an Elastomeric Infusion Pump

Continuous Passive Motion (CPM) Devices in the Home Setting

Corneal Liquid Bandage Lens for the Treatment of Persistent (Corneal) Epithelial Defects

Corneal Pachymetry Using Ultrasound

Cranial Remolding Orthoses (Helmets)

Cryosurgical Ablation of the Prostate Gland

Day Rehabilitation

Debridement of Mycotic and Symptomatic Non-Mycotic Hypertrophic Nails

Decongestive Lymphedema Therapy (DLT)

Deep Brain Stimulation (DBS)

Denosumab (Prolia™, Xgeva™)

Dental Extractions Prior to Cardiac Surgery, Radiation Therapy, or Transplant Surgery

Diagnosis Criteria for Reimbursement of Emergency Room Services

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Diagnostic and Therapeutic Radiopharmaceutical Agents

Diagnostic Radiology Services Included in Capitation

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Digital Breast Tomosynthesis

Direct Access Obstetrics/Gynecology (OB/GYN)

Dofetilide (Tikosyn®) Use in the Inpatient Setting

Drug-Eluting Beads and Bland Embolization for the Treatment of Hepatic Malignancies

Durable Medical Equipment (DME) Not Subject to a Rental to Purchase Maximum

Durable Medical Equipment (DME)

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Ecallantide (Kalbitor®)

Echocardiography Contrast Agents

Eculizumab (Soliris®)

Elective Abortion

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Electrical Stimulation and Electromagnetic Stimulation for the Treatment of Wounds

Electrocardiogram (ECG/EKG) Reported with Single Photon Emission Computed Tomography (SPECT) for Myocardial Perfusion Imaging (MPI)

Electromyography (EMG) Studies: Needle EMG, Surface EMG (SEMG)

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Electromyography (EMG) (Needle and Non-Needle) of the Anal or Urethral Sphincter

Electron Beam Computed Tomography (EBCT) for Screening Evaluations

Electrosleep Therapy using a Cranial Electrical Stimulation Device

End-Diastolic Pneumatic Compression Therapy

Endometrial Ablation

Endovascular Grafts for Abdominal Aortic Aneurysms (AAA), Aortic-Iliac Aneurysms, and Infrarenal Aortic Aneurysms

Endovascular Stent-Graft Repair of the Thoracic Aortic Aneurysm and Dissection

Enzyme Replacement for the Treatment of Gaucher's Disease (eg, Alglucerase [Ceredase®], Imiglucerase [Cerezyme®], Velaglucerase Alpha [VPRIV™]).

Epoprostenol (Flolan®) and Treprostinil (Remodulin®)

Equipment, Supplies, and Pharmaceuticals for the Treatment of Diabetes

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Eribulin Mesylate (Halaven™)

Erythropoiesis-Stimulating Agents (ESAs)

Evaluation and Management of Autism Spectrum Disorders (ASD)

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Evaluation and Management (E&M) of Diabetic Peripheral Neuropathy with Loss of Protective Sensation (LOPS)

Evaluation and Treatment of Erectile Dysfunction

Evaluation or Setup of a Cardiac Pacemaker Reported with an Electrocardiogram (ECG/EKG)

Excision of Redundant Skin

Experimental/Investigational Services

Attachment A

External Counterpulsation (ECP)

Extracorporeal Shock Wave Therapy (ESWT) for Musculoskeletal Conditions

Extraction of Bony Impacted Teeth and Exposure of Impacted Teeth

Facility Reporting of Observation Services

Fetal Fibronectin Enzyme (fFN) Immunoassay

Fetal Surgery

First-Trimester Prenatal Screening for Fetal Aneuploidy

Food and Drug Administration (FDA) Approval of Medical Devices

Foot Orthotics and Other Podiatric Appliances

Full-Body Computerized Tomography (CT) Scan Screening

Full-Body Monoplace or Multiplace Chamber Hyperbaric Oxygen Therapy

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Gastric Electrical Stimulation (Enterra™), Gastric Pacing

Genetic Testing for Congenital Long QT Syndrome

Genetic Testing for Inherited Breast Cancer 1 (BRCA1) and Breast Cancer 2 (BRCA2) Mutations

Genetic Testing for Inherited Susceptibility to Colon Cancer and Microsatellite Instability Testing (Familial Adenomatous Polyposis and Lynch Syndrome)

Genetic Testing

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Guidelines for Well Mother/Well Baby Visits Under the Mother's Option Program

Hair Transplants and Cranial Prostheses (Wigs)

Hematopoietic Stem Cell Transplantation (Bone Marrow Transplant)

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High-Frequency Chest Wall Oscillation Devices

High-Technology Diagnostic Radiology Services

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High Osmolar Contrast Agents

Hip Resurfacing

Home-Use Light Box for the Treatment of Seasonal Affective Disorder (SAD)

Home Health Care Services

Home Oxygen Therapy

Home Use of Interferential and Sequential Stimulation Devices

Home Uterine Activity Monitoring (HUAM) Devices

Home Visits by a Physician

Hospice and Respite Care